{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHANON   D JACKSON","gend":1,"add":"7946 HOWERTON ROAD","city":"DUNNSVILLE","state":"VA","zip":"22454-9998","dob":"1978-07-25","age":"","mstatus":"","insh":"1738865*01","cliId":"","pno":"804\/238-4042","cno":"804\/296-0628","email":"","ename":"","eno":"","pphy":"WILSON, AMY A NP","ppno":"804\/443-5378","pcpadd":"1362 TAPPANANNOCK BLVD","pcpcity":"TAPPAHANNOCK","pcpstate":"VA","pcpzip":"22560","pcpcounty":"","pcpid":"","pcpname":"TAPPAHANNOCK PRIMARY CARE","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/443-9667","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M72.2","M79.671","M24.274","D50.0","R10.13","Z01.812","Z20.822","F32.1","Z68.33","Z01.419","M54.5","Z98.84","Z80.0","Z68.34","V58.89","Z71.2","D61.09","Z68.32","H60.331","Z87.19","R03.0","D50.8","R51.9","N39.0","R10.9","Z13.220","Z11.59","Z13.31","K25.3","R10.31","T85.898A","K28.9","K25.9","K44.9","NO DATA","K64.9","F32.9","R10.11","N94.89","M54.40"],"date":["2020-11-13","2020-11-13","2020-11-13","2021-02-08","2021-03-04","2021-05-15","2021-05-15","2021-09-03","2021-09-03","2020-07-08","2021-04-05","2021-06-01","2021-05-19","2021-03-10","2020-12-15","2020-12-15","2021-04-13","2020-12-15","2020-10-29","2020-10-29","2020-10-29","2021-03-10","2021-04-05","2021-04-13","2021-04-13","2021-06-01","2021-06-01","2021-06-01","2020-12-04","2021-05-19","2021-03-11","2021-03-11","2021-05-19","2021-05-19","2021-05-19","2021-05-19","2021-08-27","2021-03-10","2021-03-10","2021-03-10"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","50228043605","NAPROXEN","TAB 500MG","15","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","52268001201","SUPREP","SOL PREP KIT","354","Select","Select",""],["","67877021660","CEFUROXIME","TAB 500MG","14","Select","Select",""],["","65862056099","PANTOPRAZOLE","TAB 40MG","180","Select","Select",""],["","00093914701","VENLAFAXINE","TAB 25MG","120","Select","Select",""],["","65162047810","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","50228018005","GABAPENTIN","CAP 300MG","42","Select","Select",""],["","51293081001","PHENAZOPYRID","TAB 100MG","6","Select","Select",""],["","55111014512","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","52268020101","SUTAB","TAB ","24","Select","Select",""],["","65162027250","SMZ\/TMP","TAB 800-160","6","Select","Select",""],["","81131000720","D3","CAP 2000UNIT","30","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}